ArticleChest2015
Pulmonologists' Reported Use of Guidelines and Shared Decision-making in Evaluation of Pulmonary Nodules: A Qualitative Study.
Article in Chest, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Shared decision-making in the management of pulmonary nodules: a systematic review of quantitative and qualitative studies.BMJ open · 2024Pooled it
- A Randomized Study of Patient Risk Perception for Incidental Renal Findings on Diagnostic Imaging Tests.AJR. American journal of roentgenology · 2018Trial
- Are respiratory physicians adherent to guidelines when evaluating pulmonary nodules?Internal medicine journal · 2026Article
- Clinicians' cancer risk assessment among patients with pulmonary nodules: a qualitative study.Annals of the American Thoracic Society · 2026Article
- Article
- Evaluation of Lung Cancer Risk Among Persons Undergoing Screening or Guideline-Concordant Monitoring of Lung Nodules in the Mississippi Delta.JAMA network open · 2023Article
- Establishing a Pulmonary Nodule Clinic Service for Early Diagnosis of Lung Cancer - Review of International Options and Considerations for Greece.Risk management and healthcare policy · 2023Review
- The Intervention Probability Curve: Modeling the Practical Application of Threshold-Guided Decision-Making, Evaluated in Lung, Prostate, and Ovarian Cancers.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2022Article
- Lung Cancer Diagnosed Through Screening, Lung Nodule, and Neither Program: A Prospective Observational Study of the Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta Cohort.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2022Observational
- Article
- Follow-up of incidental pulmonary nodules and association with mortality in a safety-net cohort.Diagnosis (Berlin, Germany) · 2019Article
- Pulmonary Nodules: A Small Problem for Many, Severe Distress for Some, and How to Communicate About It.Chest · 2018Review
- Effect of an Automated Tracking Registry on the Rate of Tracking Failure in Incidental Pulmonary Nodules.Journal of the American College of Radiology : JACR · 2017Article
- Clinical Equipoise and Shared Decision-making in Pulmonary Nodule Management. A Survey of American Thoracic Society Clinicians.Annals of the American Thoracic Society · 2017Article
- Article
- What's in a Name? Factors Associated with Documentation and Evaluation of Incidental Pulmonary Nodules.Annals of the American Thoracic Society · 2016Article
- Incidental nodule management-should there be a formal process?Journal of thoracic disease · 2016Review
- Patients' Knowledge, Beliefs, and Distress Associated with Detection and Evaluation of Incidental Pulmonary Nodules for Cancer: Results from a Multicenter Survey.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2016Article
- Development of Guidelines for the Management of Pulmonary Nodules: Toward Better Implementation.Chest · 2015Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundSelecting a strategy (surveillance, biopsy, resection) for pulmonary nodule evaluation can be complex given the absence of high-quality data comparing strategies and the important tradeoffs among strategies. Guidelines recommend a three-step approach: (1) assess the likelihood of malignancy, (2) evaluate whether the patient is a candidate for invasive intervention, and (3) elicit the patient's preferences and engage in shared decision-making. We sought to characterize how pulmonologists select a pulmonary nodule evaluation strategy and the extent to which they report following the guideline-recommended approach.
methodsWe conducted semistructured qualitative interviews with 14 pulmonologists who manage patients with pulmonary nodules at four clinical sites. Transcripts of audiorecorded interviews were analyzed using the principles of grounded theory.
resultsPulmonologists reported consistently performing steps 1 and 2 but described diverse approaches to step 3 that ranged from always engaging the patient in decision-making to never doing so. Many described incorporating patients' preferences only in particular circumstances, such as when the patient appeared particularly anxious or was aggressive in questioning management options. Indeed, other factors, including convenience, physician preferences, physician anxiety, malpractice concerns, and physician experience, appeared to drive decision-making as much as, if not more than, patient preferences.
conclusionsAlthough pulmonologists appear to routinely personalize pulmonary nodule evaluation strategies based on the individual patient's risk-benefit tradeoffs, they may not consistently take patient preferences into account during the decision-making process. In the absence of high-quality evidence regarding the optimal methods of pulmonary nodule evaluation, physicians should strive to ensure that management decisions are consistent with patients' values.
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Registered trials
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